Need tips to stop going hypomanic

[CheckedSquare]

I have bipolar. Just come off an antipsychotic due to physical health problems, never want to take another, can’t either really, psychiatrist been saying we’re running out of options for 5 years, last option was lithium & Valporate. But I can’t take valporate cos of physical health now. Can’t put lithium up, so trying to stop going high without the extra meds, am slightly up but not hypomanic. Have PRN, also on antidepressant lowest dose but stopping that goes badly anxiety wise. Basically what can I do that’s not meds related? Sleeping is hard. Adequate meds controls it, but I don’t have adequate meds & won’t do. Only go up. I’m very hard to medicate physical health wise. Not sure how to stop going high without extra meds? Or if you can? If anyone has any ideas? Thanks

Not sure there are any answers, I haven’t been told, sleep, exercise, no caffeine, relax, turning lights low. Just want a solution i’m
not sure exists

I'm sorry I haven't been able to ever find a way without meds. My doctor put me on zopiclone, so I slept better, and 4mg of clonazepam a day. It worked, as in stopping the high on its tracks, but sent me crashing into a low.

You say you're on an antidepressant but not which one. Have you tried switching to a more sedating one like Mirtazapine instead?

I have absolutely no idea, but it sounds a terrible bind to be in. What does your consultant say about the current situation? Are they supportive?

Anyway, happy to bump you. Hopefully you’ll find someone knowledgeable.

Thanks Abiogenesis, it’s really hard isn’t it. It is mirtazapine I take at the lowest dose, it’s the only one I can take. Take clonazepam too but hate taking it. Sorry it does that to you, must be so hard. Tempted to say I’ll try stopping the mirtazapine but would have to see what’s recommended now, I know one psychiatrist wanted me off it as I go high

Thank you BottleBlondeMachiavelli bump is good! I’ve not had an appointment for ages, only admitted I’m going high to myself in the last few days. They’ve just said valporate is only option left with lithium, but I now can’t take valporate cos of new physical health issue, but that was the last plan.

How well do you manage your nutrition. Not saying it is a sole solution for a serious illness like bipolar disorder but moderating sugar highs and lows with a low glycaemic index diet, getting healthy oils, protein, lots of nuts, anti oxidants from berries etc really helps some mental health conditions.
Good luck.

When I stopped my lithium, still on quetiapine, I had to stop the mirtazapine first due to the risk of going high. I went slightly hypomanic when my lithium was at the lowest dose just before stopping completely so I stayed on that tiny dose another month. Doing all the usual stuff, sleep, routine, self care, mindfulness and it didn't escalate. I them came off the lithium completely without issues. If I'd still been on the mirtazapine I think it would have escalated more.

Thanks Bobbie12345, if I’m honest, sitting here with a large caffeinated coffee having only eaten a bit of flapjack today - I’d say badly 😬This is definitely something I can look at thank you so much. Lithium will stop the super bad highs but I’d like to be more stable than I am & this could help. Thanks I really appreciate it

Thanks Superscientist, I am actually wondering if I need the mirtazapine, as at higher doses it makes me high & I don’t get depressions or haven’t for many years. Very bad anxiety stopping it though but that was also in a mixed state during covid. It’s something to think about, I’m struggling to go high & it makes me go high! Thank you. Are you only on quetiapine? Do you think bipolar could be stable with just lithium? I’ve never just been on one.

@CheckedSquare yes I'm only quetiapine. I have been on it since 2012. I was on mirtazapine with it for about 4 months but from then until 2020 I was on only quetiapine. I have been on doses between 300 and 800mg and they have managed episodes by moving me to higher doses and lowering it for maintenance doses. I'm currently on 600mg and stable.
In 2020-2021 I developed severe treatment resistant depression and psychosis after having my daughter and ended up on quetiapine, mirtazapine, lithium and lamotrigine. When I was admitted the aim was to get me stable on the combination and then reduce to just lithium so I'd say it's possible to just be on one. I needed lithium at quite a high dose though we were targeting 1.0 but it overshot and I developed a tremor at 1.2 so they dropped it 0.9.
After a year I dropped the lamotrigine, and after 2 years I decided I to try for another baby so I had to stop the lithium and the mirtazapine. I've now been on just quetiapine again for a year. It turned out I was getting an intolerable side effects from the lithium too. I was getting feelings like I was drowning about an hour after going to bed which then caused panic attacks. It started within weeks of going on the lithium and as soon as I dropped my lithium dose by the first increment it went away. I wouldn't be against going back on lithium in the future but I would be requesting to drop the dose if this side effect reoccured and I'm not sure if personally it would be sufficient on its own at the lower doses during an episode.
Prior to being on quetiapine I tried olanzapine which made me dizzy and lamotrigine which I don't think does anything for me. I was on olanzapine and lamotrigine and a single tablet of an antidepressants sent me from suicidal to hypomanic in 8h!

I've managed to stave off antipsychotics for a while - I try and note how I'm feeling. If I find myself getting manic I go on mega long bike rides to tire out. But I'm bipolar II so haven't had mega manic episodes.

I take duloxtine and imipramine (I've exhausted all other tricyclics and SSRIs. The fear of social services getting involved if I go on antipsychotics helps a lot 🥺

I’m on just lithium but it’s very individually based depending on how you respond to drugs. I was only diagnosed a couple of years ago (in my 50s) when I had my first episode of hypomania. I had previous had some low mood but nothing very low so was not on medication for it. I was initially on olazapine. After 1 week, they added lithium and I reduced the olazapine after 3 months so I was on just lithium after 6 months. I am doing well on just lithium although I have to make sure I prioritise my sleep.

Unfortunately as how bipolar presents is so individual and the response to medication is also individual, it has to be specific plan made for each individual I think. When are you next seeing your consultant?

There is a book called ‘The Food Mood Connection’ by Uma Naidoo that might be interesting for you to read.

If it's any reassurance I've been on antipsychotics for the entire time since i have had my daughter with no social services involvement even when experiencing episodes and having an admission.

Thank you. I'm so worried due to my history, it's a very good dissuader!

I was in a mother and baby unit and there were women that had social services involvement but the deciding factor was bespoke risk assessments and the woman's diagnosis or medication weren't the deciding factors.
There was only one moment of concern for my daughter and that was when I had the belief that my daughter was evil. My partner was asked to work from home for a week whilst I could be assessed. They determined that throughout the entire time I prioritised my daughters needs, ensured she was safe and waited out the thoughts. They determined that even though my symptoms were concerning my management of the symptoms and they had no concerns about my parenting. In situation it was also a benefit from that respect that I was engaging with treatment including antipsychotics medication. I was admitted when I expressed the intention to stop my medication.

Medication is individual but personally antipsychotics have been more effective and tolerable than the mood stabilisers. The modern antipsychotics are a vast improvement that the first generation. Quetiapine for example is licensed as a mono therapy for bipolar depression as it can also work as an antidepressants which means it can be a useful drug for those like myself that are sensitive to antidepressants but prone to depressive episodes. There's a lot of misconceptions about antipsychotics but for me they have allowed me to live my life despite bipolar.

Thanks Superscientist, sounds so scary what lithium did to you. I get life dangerous symptoms below toxicity levels so have to be careful. I read you below post too, I’m the opposite mood stabilisers are so much better than antipsychotics for me. Lithium works so much better for me than anything else, for me it’s a wonder drug, been on it about 20years, besides once I decided I didn’t need it & was so unwell. I hate antipsychotics. Good quetiapine works for you though. I feel more well on lithium, saw a psychiatrists video online & they were talking about things about how drugs work & don’t know if I remember right but lithium changes things at a cellular level so treats the cause (it was very sciency so didn’t actually follow that bit) & lithium treats at that point, antipsychotics work when the problem is further down the line. Things work best for different people.

Bike rides are a good idea, especially when there’s hills!! Thank you. Why do you think antipsychotics would be a problem for social services?

Thanks Springtimeclouds, that’s helpful to know you’re just on lithium. Prioritising sleep is not something I’m good at. It is so individual, you’re right, it’s such a different illness for everyone. I don’t want to talk to a psychiatrist as worried they’ll want me to take more meds.

Oh brilliant thank you. I’ll have a look do need to sort my diet out!

I'm probably just really paranoid that any hint of poor mental health and my DD will be taken away. It may be misplaced anxiety.

Hills are great. Go out for several hours!

Yes it's very person dependent. I am grateful for the lithium it made a huge difference when I was in a hole where nothing was working.
Apologies for the side track I just think some times the conception of antipsychotics is worse than the reality so was just wanting putting that across. I think there are misconceptions about lithium too so I do challenge them when I see it too.

Yes they don't quite understand how it works exactly but lithium is the only bipolar treatment that is neuroprotective and actually treat the condition rather than the symptoms. It is reassuring that the lithium helped when nothing else was helping so I would go back on it if found myself in that place again.

On the exercise front, I can't do anything beyond pilates and yoga when my mood is going high. I have to adopt a very calm lifestyle as there is no burning off the energy the more I do the more energy I get. I remember going for a walk with friends up a quite a large hill by the time we got to the top and they were getting tired I was cartwheeling!

I’m sorry you live with that fear, must be so hard.
Hills sound good!

No need to apologise, I’ve just tried most of them & physically don’t get on with them. It’s good to challenge misconceptions.

if you want to see it go on YouTube & it’s a video by Dr Tracey Marks called Lithium v antipsychotics the rise, fall & rise again of lithium - she’s a psychiatrist. They do know how lithium works now according to that video & she explains it well, can’t say I fully understand the science but she explains it so you do understand. Don’t want to say what it says incase misquote, but it’s a very good in depth science video explained in non doctor terms. It’s the second half of the video.

I get that about energy, it can definitely make you get more energy. Think it depends I get so many types of highs depends which it is, could manage yoga or Pilates though, how do you stay that still?

There are a few theories on how it works but it's a difficult field to research and lithium is harder to study that other drugs as some methods of determinating how it behaves with the brain and within protein are unavailable for lithium. I work in drug discovery and a lot of the methods the company I worked for used to study how our compounds worked were unsuitable for lithium!

Re yoga and pilates.... With difficulty after a certain point! I do a weekly pilates class and i do find that helpful for managing my moods.